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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153801429
Report Date: 01/04/2023
Date Signed: 01/04/2023 01:31:40 PM

Document Has Been Signed on 01/04/2023 01:31 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:SAN DIEGO CHILD DEVELOPMENT CENTERFACILITY NUMBER:
153801429
ADMINISTRATOR:ZENAIDA PEREZ VELASQUEZFACILITY TYPE:
850
ADDRESS:10300 1/2 SAN DIEGO STREETTELEPHONE:
(661) 845-6833
CITY:LAMONTSTATE: CAZIP CODE:
93241
CAPACITY: 71TOTAL ENROLLED CHILDREN: 71CENSUS: DATE:
01/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Gloria LlanesTIME COMPLETED:
01:45 PM
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On January 4, 2023, Licensing Program Analyst (LPA) Beneroso met with the facility acting Director Gloria Llanes for the One Year Required inspection. The purpose of the visit was disclosed and a tour of the facility was conducted. Upon arrival LPA observed 2 classrooms in use with a total of 9 children. There were 4 teachers total, 2 in each classroom and the site supervisor. Days and hours of operation are Monday-Friday 5am-5pm year-round. Facility has a total of 4 classrooms. Incidental Medical Services (IMS) were discussed.

Indoor/Children’s Area:
Child care center is clean, safe, sanitary and in good repair; all outdoor and indoor passageways, stair ways, incline, ramps, open porches and other areas of potential hazard are kept free of obstruction; floors of all rooms have a surface that is safe and clean, cleaning compounds inaccessible, poisons locked, furniture/equipment is good condition, free of flies, other insects, rodents; tables/chairs provided to meet children’s needs; all play equipment and materials used by children are age-appropriate, each child has an individual permanent or portable storage space for his/her clothing, personal belongings and or bedding. Children use disposable drinking cups which are located in each classroom. Each room has drinking water by filtered water source.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE: DATE: 01/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/04/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SAN DIEGO CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 153801429
VISIT DATE: 01/04/2023
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Trash cans for solid waste have tight fitting lids, drinking water is readily available indoors and outdoors All materials and surfaces are toxic free are inaccessible, there is no fire fireplace. There is a working Carbon monoxide detector as well as, smoke detector. Fire Extinguishers were in operable condition. There is a working telephone.

Restrooms: LPA inspected and observed all bathrooms, sinks and toilets to be in good, operable condition. LPA observed soap, toilet paper and paper towels readily available. Water temperature is appropriate. There is an isolation area for children who become ill while in care located in director’s office, facility maintains a comfortable temperature at all times, first aid supplies (thermometer, bandages, scissors), sign in/out sheets (manually) available and completed daily. No Smoking prohibited on the premises, daily inspection for illness, no prohibited childcare items observed. Firearms/weapons are not allowed or stored on premises. There is no body of water on the premises.



Napping: LPA observed a sufficient quantity of cots available for napping children. LPA observed children's personal sheets in each cubby.

Outdoor: The facility has one playground area for the children enrolled. Outside play area is completely fenced. Outdoor play equipment was inspected for health, safety, good repair and age appropriateness. The area was observed to be free of debris, free from hazard, holes, broken items, debris, cushioning material underneath. No bodies of water were observed. There are areas for shade and rest. Children have their personal drinking cups labeled with their name on them.

LPA observed storage sheds in the playground area secured and locked

Staff/Personnel Records: Records were verified and are complete. Qualifications, immunization, TB clearance, health screening, criminal record statement, statement acknowledging suspected child abuse and mandated reporter were observed in file.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SAN DIEGO CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 153801429
VISIT DATE: 01/04/2023
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Children Records: Records were reviewed, verified and complete. Including Admission Agreements, ID and Emergency Information (LIC 700), Health History (LIC 702), Physician Report (LIC 701), Personal Rights (LIC 613A), Consent for Emergency Medical Treatment (LIC 627), Parent’s Rights Receipt (LIC 995), Immunization Records and TB Test (When Applicable)

Facility Records: Roster, fire/disaster drill log last completed on 08/26/22 and 08/01/22 CPR/First Aid, and mandated report training were reviewed and are all up to date. Sign in and out sheets were reviewed. The parent board was reviewed and has all the required forms posted. Fire/earthquake drills current. Roster current.

Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty. The following were observed posted as required: facility license, Personal Rights (LIC613A), Parent’s Rights Poster (PUB 394L), emergency disaster plan, earthquake preparedness checklist.

Documents Provided and or Discussed: Forms and records to keep at the facility and IMS.

Advisory/Other: First Aid kit was observed with supplies (thermometer) readily available. CPR/First Aid expires on 06/08/2024. Mandated reporter training expires 06/22/2024.

Electrical outlets: Electrical outlet on room #4 needs to be replaced as it not attached to the wall, exposing wires. This represents an immediate danger to children in care. A type A citation was issued. Other electrical outlets were observed to be inaccessible to children. There are no recalled and or prohibited toys or sleep/play equipment that were observed on the premises. There are no window cords accessible to children.
Teacher child ratios were observed, and staff name recorded. Care and supervision was evaluated to determine if the basic needs of children are met and appropriate.

Health Related Services: Medications inaccessible to children; all prescription and non-prescription medications have child’s name and are dated; written consent and instruction from child’s representative, a plan to document and report to child’s representative when medication is administered to a child; IMS plan on file (if applicable).
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SAN DIEGO CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 153801429
VISIT DATE: 01/04/2023
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Children are inspected for illnesses (wellness policy) as they arrive done by a questionnaire. A review of medication policy indicated that prescription medication is administered only with parent's written permission (licensing medication form- LIC9221 - also used). Per Director, she does not have children enrolled who require medication. LPA advised the Director if they must administer medication, and document the dosage, date and time onto a log. Medication can be brought and taken home by the parent daily. Medication will be properly labeled and stored in its original container. There is a separate area for isolation and care of ill children in the Director's office.

This facility does not provide Incidental Medical Services – IMS.
LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childquanda.htm

Food Service: There is a clean, fully equipped kitchen with refrigerator/freezer, microwave, and oven. Menus are posted as required. The facility currently does not have a food program. Meals such as breakfast, lunch, and snacks are provided.

Director advised of the requirement to report Unusual Incidents. Licensee informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department (email address on the website: www.unusualincidentreport@dss.ca.gov). A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The On Duty Worker is available for questions at (661) 202-3318 Monday through Friday 8am-5pm.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SAN DIEGO CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 153801429
VISIT DATE: 01/04/2023
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Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. Director shall permit the Department to inspect the family child care home, and to privately interview children or staff, to determine compliance with or to prevent violations of child care center or regulations, also enter and inspect any place providing personal care, supervision and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation.

Based on LPA’s observation, Type A citation was issued under Section 101238(a). Per licensee, corrections will take place immediately.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Director Gloria Llanes. This report was read and provided to Gloria Llanesalong with her appeal rights.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023
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Document Has Been Signed on 01/04/2023 01:31 PM - It Cannot Be Edited


Created By: Barbara Beneroso On 01/04/2023 at 01:03 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: SAN DIEGO CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 153801429

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/04/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101238(a)
Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observations the licensee did not comply with the section cited above. LPA observed an electrical outlet in room number 4 with exposed wires, not fully attached to the wall which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/05/2023
Plan of Correction
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Facility will have outlet fully repaired by 01/05/2023. Director must submit photo proof of outlet repairs to LPA via email, text message or fax.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Mariela Ramon
LICENSING EVALUATOR NAME:Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:
DATE: 01/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/04/2023


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